NPIMap

Organization Active NPI

San Mateo Psychological Services

  • Health Maintenance Organization
  • San Mateo, CA
National Provider Identifier
1386885077
Registry record updated May 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
PSY7955 Issued in CA
Legal business name
SAN MATEO PSYCHOLOGICAL SERVICES
Practice address
100 S Ellsworth Ave
# 802
San Mateo, CA 94401-3939
Phone
(650) 343-6955
Fax
(650) 343-6981
NPI assigned
Mar 10, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John Bradshaw
Title
Owner-Director
Phone
(650) 343-6955

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X PSY7955 CA Primary

Addresses

Primary practice location

100 S Ellsworth Ave
# 802
San Mateo, CA 94401-3939

Mailing address

100 S Ellsworth Ave
# 802
San Mateo, CA 94401-3939
Phone (650) 343-6955

National Provider Directory

National Provider Directory

Locations

100 S Ellsworth Ave
Ste 802
San Mateo, CA 94401
Phone (650) 343-6955

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241654400000",
    "number": "1386885077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S ELLSWORTH AVE",
            "address_2": "# 802",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013939",
            "telephone_number": "650-343-6955",
            "fax_number": "650-343-6981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S ELLSWORTH AVE",
            "address_2": "# 802",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013939",
            "telephone_number": "650-343-6955",
            "fax_number": "650-343-6981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MATEO PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-10",
        "last_updated": "2009-05-07",
        "status": "A",
        "authorized_official_last_name": "BRADSHAW",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER-DIRECTOR",
        "authorized_official_telephone_number": "650-343-6955",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "CA",
            "license": "PSY7955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Mateo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.